Nathani M G, Mutchnick M G, Tynes D J, Ehrinpreis M N
Department of Internal Medicine, Wayne State University, Detroit Medical Center, Michigan, USA.
Am J Gastroenterol. 1998 Aug;93(8):1363-5. doi: 10.1111/j.1572-0241.1998.00418.x.
Amoxicillin/clavulanic acid is a widely used antibiotic. Hepatic dysfunction is a rare adverse reaction associated with this combination antibiotic. We report the case of a 40-yr-old woman with a somewhat unusual presentation of amoxicillin/clavulanate-related cholestatic hepatotoxicity and multiple duodenal erosions whose diagnosis was delayed until inadvertent rechallenge with the antibiotic combination. The relevant literature is also reviewed and discussed. The diagnosis may be missed because the onset of signs/symptoms may occur several weeks after the cessation of therapy. The hepatic dysfunction, which may be severe and is more prevalent in elderly patients, is usually reversible, although chronic liver disease and deaths have been reported. Immunological hypersensitivity is considered to be the most likely mechanism resulting in liver injury. Amoxicillin/clavulanate should be used with caution in patients with underlying liver disease and in the elderly.
阿莫西林/克拉维酸是一种广泛使用的抗生素。肝功能障碍是与这种联合抗生素相关的罕见不良反应。我们报告了一例40岁女性患者，其出现了与阿莫西林/克拉维酸相关的胆汁淤积性肝毒性和多处十二指肠糜烂的不寻常表现，诊断延迟至无意中再次使用该抗生素组合时。同时对相关文献进行了回顾和讨论。由于体征/症状可能在治疗停止数周后出现，诊断可能会被遗漏。肝功能障碍可能很严重，在老年患者中更常见，通常是可逆的，尽管已有慢性肝病和死亡的报道。免疫超敏反应被认为是导致肝损伤的最可能机制。对于有潜在肝病的患者和老年人，应谨慎使用阿莫西林/克拉维酸。
